A study to determine Right Heart changes and Pulmonary Artery Pressure in stable COPD patients as per GOLD criteria

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) has considerable effects on
cardiac functions primarily affecting the pulmonary vasculature and then right ventricle along
with left ventricle. These cardiac effects complicate the clinical course of COPD and
correlate inversely with survival.
Aim: A cross sectional study was conducted in stable COPD patient at National InstitueOf
Medical Science & Research, Jaipur with the following aims and objectives:-To study the
right heart changes in stable COPD patients and to determine pulmonary arterial pressure in
stable COPD patient.
Methodology: In all, 260 outdoor and indoor patients attending the Department of
Respiratory Medicine with clinical history consistent with COPD and diagnosed so as per
GOLD guidelines, between January 2018 to June 2019 and fulfilling the inclusion criteria
were included in our study. All the included subjects were evaluated in detail as regards to a
detailed clinical history and physical examination, Peripheral Blood Tests: Complete Blood
Counts, Urea, Creatinine, SGOT, SGPT, Fasting Blood Sugar. Overnight and spot sputum
sample was tested for Acid Fast Bacilli by Ziehl-Neelsen method. Other tests included Urine
routine and microscopic examination, Chest roentgenograph (Postero-Anterior view),
Spirometry and post-bronchodilator spirometry,Electrocardiography and 2D Echocardiography.
Results:Males outnumbered females in our study (61.53% and 38.46% respectively). The
mean age of the patients was 62.38 ± 11.03 years. Mean BMI was 20.5 ± 2.39 & about
44.61% of our study subject were underweight.Bidi (70.38%) was the more common type of
smoking in our COPDpatients.The majority of COPD cases had an MRC score grade 3
(45.76%). Cough (96.92%), expectoration (96.15%) & S.O.B. (98.46%) were almost
universal. All ECG & 2D Echo parameters (such as right axis deviation, right ventricular
hypertrophy and right ventricular dilatation) correlate with the severity of disease.Pulmonary
hypertension was seen in 51.15% and their existed a linear correlation between Pulmonary
hypertension& severity of the disease.
Conclusion:In lieu of the above findings, it is concluded that it is important to assess a
patient of COPD not only with clinical, radiological, spirometric criteria but also with ECG &
Echocardiography in order to assess the severity & outcome of disease.